HomeMy WebLinkAboutMortgage_Harmon (6) ... 4,i•,, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION IT � G 2�
- State Form 43709(R13/10-15) V -V—"
it'"-- .
«+'} Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS:
To be filed in person or by mail. I AN 1 4 2022 rm fled with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sough[
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is County Auditor
located on or before January 5 of the immediately succeeding calendar year. -1) ,1 aunty Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with t e/CCe�ir pj�Y
where the property is located during the twelve(12)months before March 31 oKdi#3F>PIt XM hllTt t 1i1136drl1ht.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Harmon, Kevin J. & Harmon, Deanna Fay
Taxing District Key number/legal description Record number Page number
Patoka l Sk • 26-12-15-300-001.486-027 .0'a c U
Assessed value of rea property of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of application legal or equitable owner?
$225,000.00 El Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
❑✓ Real Property ❑ MobilellH Assessed
ome(IC 6-1.1-7)
Name of mortgagee or contract seller
Springs Valley Bank & Trust Company
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
1500 Main Street Jasper Indiana 47546
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property,in a If yes,what county? What Taxing District? Has this deducti. •=en requested If yes,state amount of deduction
other county on property for FA Yes El No
in Indiana? ElYes No current year?
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or •n act indebtedness that is recorded in the county
recorder's office(including any home equity line of credit that is recorded in the county recorder's offi•')tha 's the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County Auditor \ 1 S (.1. .e)) County , ��� Date(m qth,,d ,ey�Rar)��I/We certify under the penalty of perjury that the abovegoing information is true nd correct and that the applicant a a/�r`es denntntt of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Signs re(ow er's full name) Date(month,day,year)
=—.e----_ ( �(4liM) ' /,,-,.- 4 .- --7 01/12/2022
Full r si nt address of appli (number and street,city,state,and ZIP code)
2748 East Brentwood Drive Princeton Indiana 47670
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day.year)
Address of authorized person (number and street,city,state,and ZIP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.